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CCI Edit: Mutually Exclusive Procedure

Kelly Posted Wed 26th of December, 2018 15:15:10 PM
What is the most appropriate way to handle charges when they hit a CCI Edit for "Mutually Exclusive Procedure" when a modifier is not allowed? Should the column 2 code be completely credited off the account or should the CPT code be adjusted off in billing?
SuperCoder Answered Thu 27th of December, 2018 02:52:57 AM

Hi Kelly,

Please consider the following link for all the above questions:

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/How-To-Use-NCCI-Tools.pdf

Hope this helps!

Kelly Posted Fri 28th of December, 2018 14:13:05 PM
I have utilized the resource you referenced in the past, so thank you, but I was really looking for a specific answer to my exact question. Completely credit off the charge or adjust off?
SuperCoder Answered Mon 31st of December, 2018 08:49:31 AM

Hi Kelly,

The credit off or adjust off is completely scenario specific. Having said that, some modifiers can be applied to CPT codes to allow reimbursements. 

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